ENDOSCOPIC FULL-THICKNESS RESECTION IN THE COLORECTUM USING THE FTRD: RESULTS FROM A UNIVERSITY TERTIARY REFERRAL CENTER

Aims:

The full thickness resection device (FTRD) represents a novel endoscopic treatment method for lesions not resectable with conventional endoscopic techniques. Overall aim of this study was to evaluate the technical success and the in toto resection rates, recurrence rates, as well as immediate or late complications in patients that underwent polyp removal with the FTRD.

Methods:

Data from 13 patients that underwent 14 over the scope clip-based full thickness resections were analyzed. Follow-up endoscopy was performed in 11 out of 13 patients.

Results:

14 full thickness resections were performed in 7 males and 6 females (mean age 64.5 ± 6.1 years). Mean size of the lesions removed with FTRD was 16 ± 4.7 mm. Location was rectum (n = 6), caecum (n = 2), ascending colon (n = 2), splenic flexure (n = 1) and hepatic flexure (n = 3). Mean procedure time was 72 ± 40 minutes and mean hospital stay was 2.6 ± 1.3 days. Two patients developed post-polypectomy syndrome, which resolved after conservative treatment. No perforations and no immediate surgical revision were needed. Histology of the 14 lesions removed with FTRD showed 1 tubular adenoma, 5 adenomas with low grade intraepithelial neoplasia (IEN), 4 high grade IEN, 1 fibrosis, 1 fibrosis without dysplasia and 2 adenocarcinomas. Technical success was achieved in all procedures (14/14, 100%) with R0 resection in 11/13 patients (85%). 2 patients underwent surgery because of recurrence or not evaluable margins. In one patient no residual malignancy was proven in histological examination, in the other patient residual low grade IEN adenoma.

Conclusions:

The FTRD enables minimal invasive full wall resections within the colorectum with a good success rate of complete resection and minimal side effects.